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PERMITTEE NAME/ADDRESS(lnclyde Fadliry Nanu/Lorerran ifDlperorq <br />NAME <br />ADDRESS,• _ h F F 1; ~t `" i ti 1. <br />F'. J. ~+Ix !~'1 <br />FACILITY ` ~ ~ n ~ ~ .:. :> L v ? o <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form AppfOVed. <br />DISCHARGE MONITORING REPORT (DMRJ OMB NO. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER _ - <br />MONITORING PERIOD - - ~ ~ ~ ~- ~ - - ~° 1. - ~'~ <br />YEAR MO DAY YEAR MO DAY <br />FROM "., 1 fi ` n I TO ~ 1 i r f. ~ v [~ , ? . Ili 1 >::': ~r <br />w /r~A.nlnlinn IFin inrr~ <br />). . <br />QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX of TYPE <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ,wa.ys/s <br />-' ~ SAMPLE ; ~~::f : 'r :: ,. •~.: ^ .x .. ..: .:. ,, <br />' ( 1^) <br />~ 1 , j 1 l L T ~~~X,., ~^'r~" ~`~~ a~ ~ R~4~ ~~~9 ~1 *~.,., .~„~ y~,• ~ ~Ii YYY~ ... <br />T Yt ~ a~5 ~~ ~io~l~~~ <br />SAMPLE / <br />SAMPLE <br />SAMPLE I I / - ~ \~ <br />\SUREMENT ~ ,`.~ <br />e <br /> <br />SAMPLE <br />SAMPLE <br />SAMPLE <br /> ~'~ <br />;,~. (REM ,~" r, ;~',a`q'- f w .. ~. <br />I NAME/TITLE PRINCIPAL EXECUTVE OFFICER ICerefy untler penalty of law that Nis tlowment end all attachments were <br />i <br />I <br />t <br />tl <br />tl <br />tl <br />tl <br />tli <br />i <br />i <br />i <br />tl <br />iN TELEPHONE DATE <br /> 1 gne <br />on <br />n attor <br />ence w <br />a sys <br />em <br />ea <br />prepare <br />un <br />er my <br />rect <br />on or superv <br />s <br />t0 eswra Ihet qualified perwnnel properly gather eno eraluate the IMOmation A ~ <br />~ <br />~~_~ <br /> Wi GOTd'~n Petits cuhmlltetl. Based onmy'mpulryUthepersonorparsonawhomvlegethesystem. ~ <br />` /i's~t' 70-8[4•-4401 ): r)i 'S <br /> thelnbnnetlon <br />°rUgc°peraorutlirectlyreaponsibleforpeNeringthelMolmetlon <br /> Pr~eident/Canal al Mana 0L <br />$ . <br />cubmittetl la , tp the best of my lalovAetlge antl beliol, true, accurate, entl mmplete. <br />Inb <br />tl <br />I <br />ti <br />f <br />tt <br />i <br />l SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />- TYPED OR PRINTED pna <br />on, <br />ern ev2re thm Chore ere signiflram penal <br />es <br />or subm <br />t <br />ng fa <br />se <br />intladinp Ne oossibiliN Olfine end MOriapnmem br knovMp violations. OFFICER OR AUTHORIZED AGENT <br />_ <br />Cnoc <br />NUMBER <br />YEAR <br />MD <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) <br />,;~ ?")TAL Ii(').i L1:•.I'... ..1LL .. °n./"":i, 6": .'TTL'r.0 :.L ~ ,..~'.. ..,F"I ~ '.}...F ~ .-. , ,Ir "'1F ''1''- .- <br />` EUkD£li 7F t'iC7F HE]UIK"r_~._;t:TS UNn°4; I.A. 1, P:..i.°IT~, _ `. .~., i 'PM1~~. .,, i. c?IiJ'1y i ~ ~ ~ ., i .. :. J. <br />EPA Focm 2d1 /9) revious e i ons may a use ' " ' ' - ' '' " ~~ ` ~ ' "' ' <br />~ n ~? ~ THIS IS A 4-PdRY FORM PAGE ' OF~• ' <br />.!!_ <br />